{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T01:16:49Z","timestamp":1782609409687,"version":"3.54.5"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T00:00:00Z","timestamp":1697328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>A coronally advanced flap combined with a subepithelial connective tissue graft is considered the gold standard for achieving root coverage on exposed root surfaces. Nevertheless, challenges arise when this technique is applied to multiple teeth and when the palatal soft tissue is very thin. Several surgical modifications have been reported to simultaneously achieve both single or multiple root coverage and widening of the keratinized gingiva. In this context, there have been no reported cases utilizing the submerged technique with partially de-epithelialized free gingival grafts. We intend to introduce a submerged technique involving partially de-epithelialized free gingival grafts for the modification of soft tissue phenotypes in the maxillary anterior region.<\/jats:p>","DOI":"10.3390\/medicina59101832","type":"journal-article","created":{"date-parts":[[2023,10,15]],"date-time":"2023-10-15T10:47:32Z","timestamp":1697366852000},"page":"1832","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Submerged Technique of Partially De-Epithelialized Free Gingival Grafts for Gingival Phenotype Modification in the Maxillary Anterior Region: A Case Report of a 34-Year Follow-up"],"prefix":"10.3390","volume":"59","author":[{"given":"Won-Bae","family":"Park","sequence":"first","affiliation":[{"name":"Department of Periodontology, School of Dentistry, Kyung Hee University, Seoul 02447, Republic of Korea"},{"name":"Private Practice in Periodontics and Implant Dentistry, Seoul 02771, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wonhee","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Prosthdontics, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8140-3095","authenticated-orcid":false,"given":"Philip","family":"Kang","sequence":"additional","affiliation":[{"name":"Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, NY 10027, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7695-1708","authenticated-orcid":false,"given":"Hyun-Chang","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Periodontal-Implant Clinical Research Institute, School of Dentistry, Kyunghee daero 23, Dongdaemoon-gu, Seoul 02447, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2364-8366","authenticated-orcid":false,"given":"Ji-Young","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Division of Dentistry, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1902\/jop.1987.58.10.674","article-title":"Root coverage with the free gingival graft. Factors associated with incomplete coverage","volume":"58","author":"Miller","year":"1987","journal-title":"J. Periodontol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.4103\/jisp.jisp_102_18","article-title":"Efficacy of free gingival graft in the treatment of Miller Class I and Class II localized gingival recessions: A systematic review","volume":"23","author":"Deo","year":"2019","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_3","first-page":"8","article-title":"Complete coverage of the denuded root surface with a one-stage gingival graft","volume":"3","author":"Holbrook","year":"1983","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_4","first-page":"65","article-title":"Root coverage using free soft tissue autografts following acid application. I. Technique","volume":"2","author":"Miller","year":"1982","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1902\/jop.1993.64.4.315","article-title":"Thick free gingival and connective tissue autografts for root coverage","volume":"64","author":"Jahnke","year":"1993","journal-title":"J. Periodontol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.jdent.2008.05.007","article-title":"Can subepithelial connective tissue grafts be considered the gold standard procedure in the treatment of Miller Class I and II recession-type defects?","volume":"36","author":"Chambrone","year":"2008","journal-title":"J. Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1111\/j.1600-051X.2010.01550.x","article-title":"Patient morbidity and root coverage outcome after subepithelial connective tissue and de-epithelialized grafts: A comparative randomized-controlled clinical trial","volume":"37","author":"Zucchelli","year":"2010","journal-title":"J. Clin. Periodontol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4504","DOI":"10.3390\/ijerph18094504","article-title":"Complications in the Use of Deepithelialized Free Gingival Graft vs. Connective Tissue Graft: A One-Year Randomized Clinical Trial","volume":"18","author":"Ripoll","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_9","first-page":"538","article-title":"The connective tissue graft wall technique to improve root coverage and clinical attachment levels in lingual gingival defects","volume":"11","author":"Zucchelli","year":"2016","journal-title":"Int. J. Esthet. Dent."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1002\/cap.10062","article-title":"Partly Deepithelialized Free Gingival Graft for Treatment of Lingual Recession","volume":"9","author":"Kinaia","year":"2019","journal-title":"Clin. Adv. Periodontics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1111\/jcpe.12269","article-title":"Coronally advanced flap + connective tissue graft techniques for the treatment of deep gingival recession in the lower incisors. A controlled randomized clinical trial","volume":"41","author":"Zucchelli","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s40729-023-00468-0","article-title":"Evaluation of esthetic outcome of delayed implants with de-epithelialized free gingival graft in thin gingival phenotype with or without immediate temporization: A randomized clinical trial","volume":"9","author":"Fawzy","year":"2023","journal-title":"Int. J. Implant Dent."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/j.1600-051X.2012.01896.x","article-title":"The partly epithelialized free gingival graft (pe-fgg) at lower incisors. A pilot study with implications for alignment of the mucogingival junction","volume":"39","author":"Cortellini","year":"2012","journal-title":"J. Clin. Periodontol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/prd.12186","article-title":"Periodontal plastic surgery of gingival recessions at single and multiple teeth","volume":"75","author":"Cairo","year":"2017","journal-title":"Periodontol. 2000"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1902\/jop.1985.56.12.715","article-title":"Subepithelial connective tissue graft technique for root coverage","volume":"56","author":"Langer","year":"1985","journal-title":"J. Periodontol."},{"key":"ref_16","first-page":"CD007161","article-title":"Root coverage procedures for treating localised and multiple recession-type defects","volume":"10","author":"Chambrone","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.tripleo.2007.03.013","article-title":"Subepithelial connective tissue graft in the treatment of multiple gingival recession","volume":"104","author":"Dembowska","year":"2007","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endo."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"776","DOI":"10.4103\/0972-124X.147431","article-title":"The pouch and tunnel technique for management of multiple gingival recession defects","volume":"18","author":"Dani","year":"2014","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"398","DOI":"10.5051\/jpis.2101400070","article-title":"Modified tunneling technique for root coverage of anterior mandible using minimal soft tissue harvesting and volume-stable collagen matrix: A retrospective study","volume":"6","author":"Lee","year":"2021","journal-title":"J. Periodontal. Imp. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1902\/jop.1978.49.7.357","article-title":"Treatment of Localized Gingival Recessions. Part II. Coronally Repositioned Flap with a Free Gingival Graft","volume":"49","author":"Caffesse","year":"1978","journal-title":"J. Periodontol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1902\/jop.1992.63.5.477","article-title":"The connective tissue and partial thickness double pedicle graft: A predictable method of obtaining root coverage","volume":"63","author":"Harris","year":"1992","journal-title":"J. Periodontol."},{"key":"ref_22","first-page":"279","article-title":"Single incision technique to harvest subepithelial connective tissue grafts from palate","volume":"19","author":"Hurzeler","year":"1999","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"676","DOI":"10.4103\/0972-124X.119294","article-title":"Modified single incision technique to harvest subepithelial connective tissue graft","volume":"17","author":"Kumar","year":"2013","journal-title":"J. Indian Soc. Periodontol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1111\/jcpe.13452","article-title":"De-epithelialized gingival graft versus subepithelial connective tissue graft in the treatment of multiple adjacent gingival recessions using the tunnel technique: 1-Year results of a randomized clinical trial","volume":"48","author":"Bakhishov","year":"2021","journal-title":"J. Clin. Periodontol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Bednarz, W., Majer, J., Pakuszy\u00b4nska-B\u0142aszczyk, J., Dominiak, M., Gedrange, T., and Zielinska-Pa\u0142asz, A. (2021). Coronally Advanced Flap in the Treatment of Multiple Adjacent Gingival Recessions along with a Connective Tissue Graft Harvested from Augmented or Nonaugmented Palatal Mucous Membrane: A Two-Year Comparative Clinical Evaluation. Appl. Sci., 11.","DOI":"10.3390\/app11031081"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1902\/jop.2015.150346","article-title":"Relative Composition of Fibrous Connective and Fatty\/Glandular Tissue in Connective Tissue Grafts Depends on the Harvesting Technique but not the Donor Site of the Hard Palate","volume":"86","author":"Bertl","year":"2015","journal-title":"J. Periodontol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S123","DOI":"10.1111\/jcpe.12185","article-title":"The addition of soft tissue replacement grafts in plastic periodontal and implant surgery: Critical elements in design and execution","volume":"41","author":"Zuhr","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1902\/jop.2002.73.3.340","article-title":"Formation of a cyst-like area after a connective tissue graft for root coverage","volume":"73","author":"Harris","year":"2002","journal-title":"J. Periodontol."},{"key":"ref_29","first-page":"465","article-title":"Epithelial inclusion cyst after free gingival graft: A case report","volume":"27","year":"2007","journal-title":"Int. J. Periodontics Restor. Dent."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1902\/jop.1998.69.6.717","article-title":"Treatment of a previously placed autogenous masticatory mucosa graft (free gingival graft). A case report","volume":"69","author":"Harris","year":"1998","journal-title":"J. Periodontol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1902\/jop.2010.090381","article-title":"Free gingival grafts: Graft shrinkage and donor-site healing in smokers and non-smokers","volume":"81","author":"Silva","year":"2010","journal-title":"J. Periodontol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1097\/ID.0000000000000656","article-title":"Long-Term Clinical and Radiographic Observation of Periimplant Tissues after Autogenous Soft Tissue Grafts: A 15-Year Retrospective Study","volume":"26","author":"Park","year":"2017","journal-title":"Implant Dent."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1832\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:07:09Z","timestamp":1760130429000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/10\/1832"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,15]]},"references-count":32,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["medicina59101832"],"URL":"https:\/\/doi.org\/10.3390\/medicina59101832","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,15]]}}}